Nearly two dozen people gathered at the Boothbay Harbor Memorial Library Tuesday evening, Sept. 23, to learn from a local health practitioner about the dangers of the overuse of antibacterial medicine.

For 25 years, Dr. Judy Stone conducted her own medical practice in Cumberland, Maryland. She now works at several community hospitals and as an expert on infectious diseases and has published her work in textbooks and in blogs such as Scientific American. She donated her time to the library this week as part of the Boothbay Region Health and Wellness Foundation's series of Wellness Forum talks geared toward enlightening the public about medical and health issues.

Stone began by speaking about her first days working with antibiotics.

"When I started working with infectious diseases, Cefalexin was the newest antibiotic," she started. "I though it would be a cheery set of years, but instead I see a lot of people in futile care."

This statement set the stage for much of Stone's talk. Antibiotics, since the earliest days of their creation, have been on the way out. Fewer new drugs are being developed each year, Stone said, and the drugs currently on the market are being over-prescribed and mishandled, and that is leading to drug-resistant bacteria. Stronger bacteria is better able to combat new and stronger drugs, and as a result, even the newest antibiotics are not working as well.

Stone paints a picture that she described as having a "grim" future where, in a matter of decades, antibiotics will no longer work because bacteria will be able to fight off anything patients throw at them.

The downfall of antibiotics

This begs the question, she indicated, about how the current situation got to where it is. Stone said she had hope for the future of antibiotics when she began her work with infectious diseases, but she places blame of the downfall of their effectiveness on three specific areas: the use of antibiotics in agriculture; doctors' over-prescription of antibiotics for patients who do not need or, in her opinion, should not receive antibiotics; and poor management of medical care by both patients and their doctors.

First, she notes that the agriculture industry often uses antibiotics to promote animal health. Farmers can place antibiotics in animal feed to achieve that goal, but like it is with humans, bacteria in animals are also developing resistance to the drugs.

And those resistant bacteria can make their way across species, for example from pig or cow to humans, through their dietary choices. She notes that governmental legislation in Europe has halted the practice there, but calls for similar legislation in the United States have not succeeded, and it appears that consumer food preferences are doing more good than proposed laws.

"Many people are demanding antibiotic-free meat," Stone said, "and that has done more good than legislation."

Additionally, Stone says that many doctors are using shortcuts regarding patient care and are applying "broad-spectrum" antibiotics that are also degrading the future of this type of medicine.

Broad-spectrum drugs, compared against narrow-spectrum varieties, target a wider array of pathogens, so they can be used as a catch-all that may target the ailments of patients but may also target other bacteria that is not harming patients, and that leads to more chances for different types of bacteria to become resistant to those drugs.

In one example, she pointed to Zyvox, a brand-name for the drug Linezolid, and said it is "being wasted like nobody's business." That is a drug she said she feels should be part of a national security plan — not for daily use.

"It is prescribed a lot because it can be taken by mouth," she continued. "I see it used a lot in nursing homes for its convenience."

Stone said there are some antibiotics that are easier than others for patients to take. Pills may be easier than intravenous injections, for instance, and doctors are prescribing them even if they are not always the correct tool for the job.

In addition, she said doctors are often using antibiotics in situations where their use is either unnecessary or flat-out wrong. She points to doctors prescribing antibiotics for urinary tract infections when patients show no symptoms. Similarly, doctors may prescribe antibiotics for a scratchy throat, but those prescriptions, she says, are unnecessary unless a patient has strep throat, and it will not make a common cold go away more quickly.

It is in cases such as sore throats, ear infections and sinus infections where patients can take matters into their own hands and help treat themselves without the use of antibiotics. Pain medicines can help ease discomfort caused by ear infections, and the use of a warm compress, neti pot or a humidifier can ease the pressure of sinus infections.

In cases where antibiotics are necessary, however, Stone also urged everyone to take full courses of medicine as prescribed. A partial course of antibiotics may not only be ineffective at treating a current infection, it can also aid bacteria in becoming more resistant to future courses of medicine.

Self-help solutions

Moving beyond the doom and gloom that colored the bulk of her talk, Stone said empowered patients can make a marked difference in proper care and can help halt the downward slide of antibiotic efficacy. She encouraged individuals in attendance to ask their doctors for details about prescribed medications.

"What am I getting? And why?" she asks.

Further, she said it is important for people to refrain from touching their faces. Individuals should also wash their hands often and insist that their doctors wash their own hands or use hand sanitizer before patient interaction. Also to that point, Stone said people should avoid the use of antibacterial soap, such as those that contain the antibiotic Triclosan, and instead opt for "good, old-fashioned soap."

"(Triclosan) is the least effective antiseptic and has the most side effects," Stone said.

In closing, although she did define the future of antibiotics as "grim," she appeared hopeful that patients could take medical matters into their own hands and use their powers of choice to positively change their health outcomes. It seems that the ability to change the use of antibiotics is within the scope of doctors' and patients' choices and responsibilities.

Doctors can be more selective and use narrow-spectrum antibiotics; they can advocate for use of normal soap and practice good hygiene in hospital settings.

Similarly, patients can inform themselves by asking their doctors detailed questions about medicine and care. They are small steps that may lead to a better future and extended potential use of antibiotic drugs, yet without those small steps, the world may be forcefully antibiotic-free in only a few decades' time.